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RC187.M46  Typhoid  fever  in  1 


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Mchigan.   Dept,    of  health. 
Typhoid  fever   in  Michigan  in  1890 • 


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TYPHOID    FEVEK 

llSr   MICHIGhAlSr   IN    1890, 


A  SUMMARY    FROM    REPORTS 


HEALTH    OFFICERS,    CLERKS    AND    PHYSICIANS, 


COMPILED  UNDEE  THE  DIEECTION  OF  THE 


SECRETARY  OF  THE  MICHl&AN  STATE  BOARD  OF  HEALTH. 


[Repeinted  feom  THE  Annital  Repoet  of  the  Michigan  State  Boaed  of  Health  foe 

THE  Yeae  1891.J 


[Reprint  N"o.  383.] 


SSAL. 


BY  AUTHOEITY. 


LANSING  : 
ROBERT  SMITH  &  CO.,  STATE  PRINTERS  AND  BINDERS, 

1898. 


TYPHOID  FEVER   IN    MICHIGAN 


DURING   THE  YEAR   ENDING   DECEMBER  31,  1890, 


r  Reprinted  from  the  Annual  Report  of  the  Michigan  State  Board  of  Health  for  the  year  1891.] 

[Repeint  No.  382.] 


There  were  reported  to  the  office  of  the  Secretary  of  the  Michigan  State 
Board  of  Health,  during  the  year  1890,  1,924  cases  of  sickness,  and  304 
deaths  from  typhoid  fever,  in  310  localities.  No  reports  of  this  disease 
were  received  from  the  following  sixteen  counties:  Alcona,  Alger,  Arenac, 
Crawford,  Gratiot,  Iosco,  Iron,  Isle  Royal,  Luce,  Mackinac,  Manitou, 
Missaukee,  Montmorency,  Ogemaw,  Presque  Isle,  Schoolcraft. 

Table  1  gives,  relative  to  typhoid  fever,  the  number  of  outbreaks,  local- 
ities, cases,  and  deaths,  average  number  of  cases  per  outbreak,  average 
number  of  deaths  per  outbreak,  per  cent  ratio  of  deaths  to  cases,  and  the 
number  of  special  final  reports  received,  for  the  seven  years,  1884-90: 

Table  1. — Typhoid  pevee. — Exhibiting  the  numher  of  Outbreaks,  Localities.  Cases 
and  Deaths  reported  for  each  of  the  seven  years,  1884-90;  also  for  some  of  those 
years  the  average  Cases  and  Deaths  per  Outbreak,  the  per  cent  ratio  of  Deaths  to 
Cases,  and  the  number  of  Special  Final  reports  received. 


Year. 

Outbreaks 
Reported. 

Localities 
Reported. 

Cases 
Reported. 

Deaths 
Reported. 

Average 
Cases  per 
Outbreak. 

Average 
Deaths  per 
Outbreak. 

Deaths  per 
100  Cases. 

Final 
Reports 
Received. 

1884 

245 

200 
282 
320 
296 
398 
310 

969 
715 
1,194 
3,424 
1,511 
2,530 
1,924 

290 
194 
282 
411 
310 
402 
304 

27 
23 
18 

■17 
21 

tl8 
16 

1885 

1886 

1887 

1888 '_ 

1886 

1890 

218 
290 
335 
316 
432 
330 

3.28 

4.15 
*7.24 

4.78 
t5.17 

5.83 

.89 

.75 
*1.23 

.98 
t.98 

.92 

60 

46 

60    1 
115 
135 

*  The  large  average  number  of  cases  and  deaths  per  outbreak  in  1887  is  partially  accounted  for  by  the 
fact  that  in  two  outbreaks  the  disease  became  epidemic,  resulting  in  an  aggregate  of  535  cases  and  7S 
deaths. 

t  In  computing  the  average  numbers  of  cases  and  deaths  per  outbreak,  and  the  per  cent  ratio  of  deaths 
to  cases  in  1889,  the  outbreak  at  Negaunee,  in  -which  300  cases  were  reported,  is  omitted,  because  the 
number  of  deaths  which  occurred  in  that  outbreak  was  not  reported. 


As  shown  in  Table  1  there  were  reported  to  this  office  606  cases  and  98 
deaths  less  for  the  year  1890  than  for  the  preceding  year.  The  average 
number  of  cases  per  outbreak  for  the  year  1890  is  slightly  more  than  for 
1889.     This  is  explained  in  part  by  the  fact  that,  during  the  year  1889, 

27 


210        STATE  BOARD  OF  HEALTH.— REPORT  OF  SECRETARY,  1891.       . 

there  occurred  an  €fj)idemic  of  this  disease,  at  Negaunee,  with  300  cases, 
which,  as  stated  in  the  (f )  foot-note  to  Table  1,  were  not  computed  in  the 
average  for  that  year. 

The  reports  received  at  this  office  show  this  disease  to  have  been  slightly 
less  fatal  during  the  present  year  than  for  the  preceding  year,  the  number 
of  fatal  cases  being  2  per  cent  (of  the  total  number  of  cases)  less  in  1890 
than  in  1889. 

In  1889  the  number  of  reported  cases  per  10,000  of  population  was  12.4, 
in  1890  it  was  only  9.2. 

Notwithstanding  the  large  decrease  in  the  number  of  reported  outbreaks 
of  this  disease  in  1890,  as  compared  with  1889,  there  is  shown  by  Table  1, 
an  increase  in  the  number  of  final  reports  received  at  this  office  relative  to 
those  outbreaks.  This  indicates  a  gratifying  increase  of  assiduity  on  the 
part  of  local  health  officials  in  the  discharge  of  their  duties. 

8tudy  of  the  regular  sickness-statistics  in  Michigan  (conclusions  from 
which  are  given  in  Exhibit  1  and  Table  8,  further  on  in  this  article)  shows 
a  decrease  in  the  per  cent  of  weekly  reports  which  stated  the  presence  of 
typhoid  fever  in  1890,  as  compared  with  1889,  which  is  corroborative  of 
the  evidence  of  the  decrease  in  prevalence  of  the  disease  as  shown  (in 
Table  1  and  the  last  three  preceding  paragraphs)  by  the  system  of  com- 
municable disease  reports  on  which  the  first  part  of  this  article  is  based. 

SOURCE  OF  CONTAGIUM  OF  TYPHOID  FEVER. 


Table  2. — Exhibiting  the  reported    "  Source   of  Contagium  "  of  Typhoid  Fever  in 

Michigan,  during  the  year  1890. 


Reported  Source  of  Contaginm. 


Number  of 

Reports  for 

each  Source  of 

Contagium 


Infected  and  impure  water 

Supposed  to  be  impure  water 

Unsanitary  surroundings... 

Defective  drainage  and  sewers  ._ 

From  a  former  case 

From  outside  jurisdiction  whence  reported 

Decaying  vegetables  in  cellar 

Overwork 

Digging  a  ditch 

Unknown 

No  source  stated 

Sporadic 

Exposure 

Bad  atmosphere 

In  milk 

By  working  on  Port  Huron  tunnel 

All  outbreaks 


54 
5 

13 
3 
7 

47 
2 
4 
1 

68 
111 
7 
5 
1 
1 
1 


330 


TYPHOID  FEVER  IN  MICHIGAN  IN  1890.  211 

Table  2  shows  that  relative  to  111  of  the  330  outbreaks  of  typhoid  fever 
reported  to  this  office  during  the  year  1890,  the  source  of  contagium  was 
not  stated,  that  in  regard  to  68  outbreaks  it  was  reported  as  "  unknown," 
and  that  in  47  instances  it  was  reported  as  having  been  brought  from  out- 
side the  jurisdictions  whence  the  outbreaks  were  reported.  In  52  per  cent 
of  the  remaining  104  outbreaks  the  source  of  contagium  was  given  as 
"  infected  and  impure  water,"'  and  in  13  per  cent  as  "  supposed  to  be 
impure  water." 

Below  are  given  extracts  from  statements  found  in  the  reports  of  local 
health  officers  with  regard  to  the  source  of  the  contagium  of  typhoid  fever. 

"  Most  probably  the  use  of  water  from  a  shallow  creek  t<3  which  geese,  dogs,  cats,  cows,  horses,  men, 
women  and  children,  both  dead  and  alive,  have  free  access."— G^eo.  &.  Barnett,  M.  D.,  Health  Officer  of 
Tilden  township,  Marquette  county. 

"Investigating  the  source  of  this  ontbreak  of  Typhoid  Fever,  I  found  the  well  under  the  house,  dug 
well,  stoned  up,  about  two  feet  of  filthy  water  containing  dead  rats,  sow  bugs  and  filth  from  scmbbLng 
floors.  Hog  yard,  hen  park  and  privy  all  within  fifty  to  seventy-five  feet  of  the  well."— iT.  C.  Maynard. 
Health  Officer  of  the  Village  of  Hartford,  Van  Buren  county. 

"  From  fiJth  of  cistern  and  reservoir,  under  the  dwelling  house,  large  enough  to  contain  water  for  the 
use  of  500  cattle  in  time  of  a  drouth."— ^tejcander  C.  Kidd,  Health  Officer,  Albee  tmcnship,  Saginaw  county. 

"  This  patient  contracted  the  disease  while  engaged  as  a  sailor.  The  vessel  on  which  he  was  working 
lay  in  Detroit  at  the  outlet  of  a  sewer.  He  drank  of  the  water."— H'.  K.  Moore,  Health  Officer,  Algonac, 
St.  Clair  county. 

"  This  fever  has  prevailed  here  every  year  during  the  summer  and  autumn  for  the  past  six  years,  and 
very  little,  if  anything  has  been  done  to  prevent  the  ravages  of  the  disease.  Much  of  the  land  in  and 
around  about  the  town  is  low  and  swampy  and  the  drainage  and  natural  water  courses  are  blocked  up  with 
slabs  and  saw  dust  along  the  whole  front  of  the  town.  Water  is  obtained  from  two  sources,  water  pipes 
in  L'.-inse  Bay,  and  surface  wells.  The  water  pipes  draw  water  from  the  bottom  of  a  shallow  bay,  only  a 
short  distance  from  the  shore,  directly  in  front  of  two  saw  mills,  and  only  a  few  feet  from  large  docks 
built  of  mill  waste.  In  summer  the  water  always  has  a  bad  odor.  As  to  the  wells,  water  can  be  obtained 
anywhere  by  digging  a  few  feet.  After  a  heavy  rain  wells  and  shallow  privy  vaults  are  running  over  so 
that  pollution  of  the  well  water  is  very  general;  and  this  is  increased  by  lack  of  drainage."— ^.  J.  Braden, 
Health  Officer,  Baraga  tcAunship,  Baraga  county. 

The  following  diagram,  on  page  212,  drawn  from  sketches  and  informa- 
tion furnished  by  Mr.  Braden,  illustrates  the  conditions  under  which  the 
water-supply  of  Baraga  is  obtained;  which  conditions  seem  to  fully  warrant 
"the  opinion  that  the  source  of  the  disease  in  Baraga  was  polluted 
drinking  water. 

TYPHOID  FEVEK  AT  SAULT  STE.  MAEIE. 

The  following  correspondence  between  the  Secretary  of  this  Board  and 
Dr.  A.  J.  Campbell,  health  officer  of  Sault  Ste.  Marie,  bears  on  the  source 
of  contagium,  and  history,  of  an  outbreak  of  typhoid  fever  which  prevailed 
at  that  place  from  August  to  October,  1890,  and  which  resulted  in  300  cases 
of  sickness  and  20  deaths.  It  also  illustrates  some  of  the  difficulties  with 
which  health  officers  have  to  contend  in  their  efforts  to  restrict  and  stamp 
out  dangerous  communicable  diseases  which  appear  in  their  jurisdictions. 

August  28,  1890,  Dr.  Campbell  wrote  to  the  :8ecretary  as  follows: 

"  I  forward  you  a  notice  of  an  outbreak  of  typhoid  fever.  I  will  send  you  a  fuller  report  soon.  The 
physicians  will  not  report.  The  prosecuting  attorney  will  not  prosecute  for  want  of  evidence.  I  can  go 
and  diagnose  typhoid  fever;  the  physician  in  attendance  says  no.  I'll  get  three  to  say  yes  ;  he  will  get  six 
to  say  no.  The  prosecuting  attorney  says,  no  evidence.  Your  health  officer  is  ignominiously  defeated. 
No  remedy.  My  salary  is  U9.3i  per  month.  Who  can  attend  to  his  duty  under  such  circumstances.  I 
wish  I  had  the  power  to  get  others  to  do  their  duty,  and  I  would  not  mind  it  so  much.  I  would  like  to 
hear  from  you  in  regard  to  the  matter.  I  have  the  law;  but  1  cannot  get  the  prosecuting  attorney  to  act. 
********** 

"  Bend  a  few  of  '  The  Prevention  of  Typhoid  Fever.'  " 


212        STATE  BOARD   OF  HEALTH.— REPORT  OF   SECRETARY,  1891. 

Plai  of  CL  ^oiftioft  of  the  i/iUct.^e  cf  Ba-raga.,M,ickigayv. 
^hou/ing  unsaiisf actor i/  iocctfion  af  ura&er  intake^. 


/,  5,  3,  S'f  %  lOy  //,  IZ,  f^,  /S,  /(>,  /7,  /r,  =  Bu/e  Hi  Tigs  . 
y,  ssBoarding-house^u/^ere  f  or /O eases  of  ^JbhoidSeirer'  occurred. 
X,=  fShalUra/  .^rivi/-\/aults  . 

o,!=7faier- CIo<sef<S  u/t'ih  leaky  bo^^rains  emptyi/rg  info  o^e»difch . 
®2:k-.-.zl^:=  Intake ^i-^efoif  u/atey  u/o-rhs  u/hc  eh  su^^t^  all  t/te  houses 
except  Z'andt  5' 

lu  replv  to  the  foregoing  letter  the  Secretary  wrote  to  Dr.  Campbell^- 
Sept.  18,  1890: 

"  I  have  mailed  to  yoar  address  40  documents  on  "  The  Prevention  of  Typhoid  Fever,  "  for  distribution 
among  those  in  your  city  who  are  in  danger. 

"I  also  sent  you  several  copies  of  a  document  on  'Typhoid  and  Typho-Malarial  Fevers'  (a  copy  of 
■which  I  herewith  enclose)  which  it  would  probably  be  well  for  you  to  distribute  among  the  practicing 
physicians  in  your  jurisdiction. 

"  I  trust  that  your  local  board  of  health  will  vigorously  endeavor  to  stamp  out  typhoid  fever  in  your 
city." 

November   18,  1890,   the  Secretary   again    wrote   to   Dr.    Campbell  as 
follows : 

"  Will  you  kindly  send  me  all  the  information  you  can  concerning  the  outbreak  (in  August)  of  typhoidt 
fever  in  your  city,  and  its  relations  to  the  detention  of  boats,  etc.? 
"  I  will  also  be  glad  to  receive  your  final  report  of  the  outbreak  when  it  is  over."  • 


TYPHOID  FEVER  IN  MICHIGAN  IN    1890. 

Tlan  of  a  ^oc-rf  of  the    City  of  JauH  'Ste,  Ji^aicie 


213 


/  =  uesseU  u/hieh  stood  S  or  ^ctays  with  i/ji^ergate  of  canal  closed . 
jfrrau/s  sAou/  current  of  u/afer  in  canal taher?  the  u^^er^ate  is  closecC. 
^-y^a-ji)  of  conditions  i?7  ^ault  Jte.  M>ariej^iohisran^u//iere 
an  outbreaA  of  tt/^hoid  Jeuer occurred.  Pfaierfordonjestic 
^ury^oses  was  us&d  from  the  eanul  uihen  ol  iargenu^rt- 
ocr  of  vssseis  me^e  detained  ft  if  e  or  six  days  u/ith  canal 
closed  uihiie  the  locks  u/ere  heina  TC^aired.  J)urin^ 
that  ii?ne  garbage  and faecocly^atcer  u/Cre  aontiTtualli/ 
thrown  into  the  canal  franr  t/'iese  iresse/s. 


214         STATE  BOARD  OF  HEAL.TH.-REPORT  OF  SECRETARY,  1891. 
In  reply  to  the  last  preceding  letter,  Dr.  Campbell  wrote: 

"  In  compliance  to  yonr  request  regarding  the  history  of  the  typhoid  fever  outbreak  in  the  city  of  Sault 
Ste.  Marie  last  summer:  The  fever  made  its  appearance  immediately  after  the  canal  locks  were  repaired. 
In  my  monthly  report  to  our  city  council  I  called  attention  to  the  impurities  of  the  water  used  for  domes- 
tic purposes  during  the  time  the  canal  was  closed,  and  when  between  three  and  four  hundred  vessels  were- 
detained  during  the  space  of  five  or  six  days.  We  sent  samples  of  water  to  Dr.  Yaughan,  Michigan  Uni- 
versity, for  analyses.  He  discovered  disease  germs— typhoid  fever  germ,  and  having  collected  the  poison 
from  the  specimen  sent,  injected,  hypodermically,  the  same  into  the  abdomen  of  a  rat,  result,  death.  One 
month  after  the  fever  began  to  abate,  I  sent  specimens  from  the  cataract  pump  house,  and  from  a  tap  in 
the  most  distant  point  from  the  pump  house,  meirking  them  Nos.  1,  2  and  3, — result,  pure,  no  disease 
germ,  no  poison. 

■■  I  enclose  you  a  diagram  of  the  water  works,  or  pump  house,  cataract  and  canal.  There  were  about 
three  hundred  cases  of  typhoid  and  typho-malarial  fevers ;  probably  20  deaths.  The  fever  began  about 
two  weeks  after  the  canal  was  opened.    First  case  reported  to  me  in  August,  the  last  on  the  20th  October. 

"  I  trust  the  State  Board  of  Health  will  urge,  with  effect,  the  propriety  of  every  town  and  city  having  a 
board  of  health.    The  council  too  often  are  under  political  obligations  that  bind  them  hand  and  foot." 

' '  The  water  in  the  bay  where  the  pump  house  is  situated  is  almost  dead  water.  The  intake  pipe  runs 
through  the  south  pier  of  the  canal  into  the  canal.  You  will  observe  the  indication  of  the  course  of  the 
water.  The  current  runs  into  the  rapids  past  the  canal;  but  a  small  current  runs  into  the  canal  and  turns 
back  if  the  upper  gate  is  closed,  and  catches  the  current  running  into  the  rapids,  x  x  x  x  show  where  the 
vessels  were  standing  for  five  days  dumping  out  diseased  garbage  and  faecal  discharges  while  the  locks 
were  being  repaired.  The  water  thus  saturated  was  taken  by  the  intake  pipe  and  thus  supplying  the  city 
byway  of  S.  8.  I  recommended  carrying  the  intake  pipe  (to  be  carried  from  a  pump  house  erected 
at  (+ )  )  to  the  center  of  the  rapids,  and  be  no  longer  at  the  mercy  of  an  accident  on  the  canal  locks." 

In  thanking  Dr.  Campbell  for  his  report,  as  given  above,  the  Secretary 
wrote : 

"  In  reference  to  the  intake  of  the  water-supply  of  your  city,  how  would  it  do  to  place  it  beyond  the 
light  house,  in  the  river,  just  above  where  it  could  receive  any  water  from  the  canal.^  If  below  the  bridge 
it  would  still  take  in  some  water  which  came  from  the  canal," 

Following  are  a  diagram  (drawn  in  this  office  from  the  one  referred  to 
in  the  above  letter)  and  explanations  thereof,  given  by  Dr.  Campbell, 
which  graphically  portray  the  conditions  under  which  the  water  supply  of 
Sault  Ste.  Marie,  believed  to  have  been  the  cause  of  the  outbreak  of 
typhoid  fever  there,  was  obtained: 

TYPHOID  FEVEE  IN  HAETFORD,  VAX  BUEEN  COUNTY. 

Relative  to  an  outbreak  of  typhoid  fever  in  the  village  of  Hartford,  of 
which  the  source  of  contagium  was  believed  to  be  impure  drinking  water, 
Dr.  H.  C.  Maynard,  health  officer  of  the  village,  wrote  to  this  office  as 
follows : 

"The  case  of  typhoid  fever  reported,  is  a  young  man  that  has  been  boarding  at  the  principal  hotel  of 
this  village  all  summer.  I  procured  and  tested  the  water  furnished  the  guests  of  the  house  and  find  it  a 
mass  of  organic  matter. 

"  I  send  you  diagram  of  the  water  supply." 

Following  is  a  diagram  made  in  this  office,  from  the  one  referred  to  in 
Dr.  Maynard's  letter. 


TYPHOID  FEVER  IN  MICHIGAN  IN  1890. 


215 


K^myfyure  source  of  waier  used  hy  yfoeyson  u/ho 
eontracted  fy^?ioidfei;er,  in  /{cLytJorcl,  ^ic/v  . 


htl^i  OTL 


St. 


JiT 


W. 


Z 


s 


am 


u/ell . 


Hotel 


Qyi'ell 


Barn 


"^v  k^'"  ,iL^  5^ 

b/  LJ  Cess-^ool 
/    slxftsq/uar*e 
and  e  i^^tft  dee^. 


Si 


^ 


INFECTED    MILK    THE    SUPPOSED    CAUSE    OF   TYPHOID   FEVER    IN   WYANDOTTE. 

Sept.  28,  1890,  Dr.  E.  P.  Christian,  of  Wyandotte,  Wayne  county,  wrote 
to  the  Secretary  of  this  Board  relative  to  typhoid  fever  in  that  city  as 
follows: — 

"  Typhoid  fever  has  been  with  us  this  fall  unusaally  prevalent  and  of  more  than  common  severity.  This 
is  rather  severe  on  the  doctors  of  onr  city  who  advocated  getting  in  water  works  as  a  sanitary  measure  in 
this  respect.  We  had  the  river  water  introduced  a  year  ago  this  fall,  and  to  have  had  such  an  increase  in 
number  and  severity  of  cases  since  its  introduction  has  led  to  the  surmise  that  we  had  been  intro- 
ducing to  our  houses  the  diluted  sewage  of  Detroit.  Perhaps  this  is  so  to  some  extent,  for  the  solid  parts 
no  doubt  settle  to  the  bottom  all  along  down,  and  when  a  heavy  wind  prevails  the  water  from  the 
penstocks  is  at  times  decidedly  roily  Eind  ofif  color. 

"  However,  the  fact  is  that  the  disease  has  prevailed  as  to  numbers,  about  equally  among  users  of  well 
water  and  of  river  water  — giving  rise  to  the  suggestion  that  we  must  look  elsewhere  for  the  cause  of  tha 
disease  than  in  the  drinking  water. 

"  This  I  have  suspected  for  a  long  time  and  have  had  a  suspicion  that  this  cause  was  in  the  milk. 

"  I  have  had  an  experience  within  the  past  two  months  which  has  strengthened  that  suspicion. 

"  In  the  family  of  Mr.  A.  two  cases  of  enteric  fever,  and  all  the  family  ailing  — in  the  family  of  T.  three 
(3)  cases  and  others  ailing,  one  deceased.  In  the  family  of  Mrs.  F.,  one  severe  case—  all  these  in  imme- 
diate neighborhood  —  all  it  is  true  using  river  water,  but  all  getting  milk  from  one  cow,  a  neighbor's  — 
also  in  Dr.  C.'s  practice  in  family  of  Mr.  T.,  one  case  getting  milk  from  same  cow,  but  also  using  river 
water.  This  animal  is  stall-fed,  kept  up  in  barn.  To  be  sure  there  have  been  many  other  cases  of  fever  in 
those  using  well  water  and  milk  from  other  sources.  But  is  it  not  singular  that  so  many  cases  have 
occurred  in  one  small  neighborhood  and  all  getting  milk  from  the  same  animal? 

"  It  would  be  worth  while  for  the  Boeird  of  Health  to  purchase  this  animal  and  investigate  her." 


216       STATE  BOARD   OF  HEALTH.— REPORT   OP   SECRETARY,  1891. 

Sept.  30,  1890,  the  Secretary  sent  to  each  member  of  this  Board  a  copy 
of  Dr.  Christian's  letter  accompanied  by  the  following  from  himself: — 

"  Dear  Sir: — I  shall  be  glad  to  receive  any  suggestions  which  you  will  make  on  the  subject  of  the  above 
letter  from  Dr.  Christian." 

Samples  of  the  milk,  of  the  river  water,  and  of  the  well  water  were  sent 
to  Prof.  Yaughan,  Director  of  the  Laboratory  of  Hygiene,  Ann  Arbor;  and 
at  the  meeting  of  this  Board  Oct.  14,  1890,  he  made  a  verbal  preliminary 
report  that  bacteriological  examination  revealed  the  fact  that  both  of  the 
samples  of  water  and  the  milk  contained  micro-organisms  which,  by  their 
life  processes,  in  nutritive  solutions,  form  poisons. 

At  the  same  meeting  Drs.  Vaughan  and  Kellogg  were  appointed  a  com- 
mittee to  further  investigate  this  subject;  and  later,  Dr.  Vaughan  reported 
as  follows  relative  to  analyses  of  waters  and  milk  sent  to  him  from 
Wyandotte : 

MICHIGAN   UNIVERSITY — LABOEATORY   OF    HYGIENE. 

^Report  of  the  Sanitary  Condition  of  Water  sent  by  E.  P.  Christian,  M. 
D.,  Wyandotte,  Michigan: 

Source  of  water,  with  remarks  on  the  sanitary  surroundings. 

No.  I.— From  H.  Millspaugli' s  ivell.    No.  II.— From  Water  Works. 

PHYSICAL  PROPEETIES. 

No.  I.  No.  II. 

Color Sedimentary Clear. 

Odor None None. 

Reaction... Neutral Neutral. 

Hardness 13 _. 7  (Clark's  Scale.) 

Chemical  Analysis  {Parts  per  Million.) 

(1)  Total  residue  obtained  by  evaporation  at  110  C. 

(2)  Residue  after  ignition,  or  inorganic  matter  in  residue 

<3)    Organic  residue,  or  loss  on  ignition 

(4)  Amount  of  earthy  bases,  calculated  as  oxides,. 

(5)  Amount  of  chlorine,  calculated  as  sodium  chloride 

(6)  Amount  of  sulphates  calculated  as  8O3 Strongtrace 

(7)  Parts  of  potassium  permanganate  reduced  by  the  organic  matter  in  the  water 

1(8)  Amount  of  free  ammonia.. 

(9)  Amount  of  albuminoid  ammonia 

XIO)  Amount  of  nitrates,  calculated  as  N2  O5 ..- 

{11)  Amount  of  nitrites,  calculated  as  No  Os 

Microscopical  Examination. — Description  of  deposit,  magnified  100 
diameters.  No.  I.  Crystals.  Yellow  amorphous  matter.  White  amor- 
phous matter.  No.  II.  Crystals.  Algse.  Yellow  amorphous  matter. 
White  amorphous  matter.  Same  magnified  500  diameters.  No.  I.  Sodium 
chloride  crystals.  Algse.  Yellow  amorphous  matter.  White  amorphous 
matter.  No.  II.  Sodium  chloride  crystals.  Silica.  Fibres.  Algse. 
Vorticellse.     Yellow  amorphous  matter.     White  amorphous  matter. 


1090. 

221. 

850. 

191. 

240. 

30. 

20.798 

10.976 

266.4 

49.5 

jng  trace 

None. 

41.08 

32.548 

0.46 

0.08 

0.56 

0.52 

13.06 

0.653 

0.247 

0.0082 

TYPHOID  FEVER  IN  MICHIGAN   IN  1890.  217 

Bacteriological  Examination. — Number  of  germs  developed  on  a  gelatin 
plate  inoculated  with  one  drop  of  water: 

No.  I.  No.  II.  Milk. 

(1)  After  24  hours -- 2480        1770        3460 

(2)  After  48  hours 2580        1890        3460 

(3)  After  72  hours 1 2580        1890        8460 

Remarks  on  the  Kinds  of  Germs  Observed. — In  No.  I.  are  two  kinds  of 
germs:  (a)  the  green  bacillus  of  water,  and  (b)  a  non-liquifying 
toxicogenic  germ.  In  No.  II.  are  two  kinds  of  germs:  (a)  the  green 
bacillus  of  water,  and  (b)  a  liquifying  toxicogenic  germ.  In  the  milk 
there  are  three  or  four  kinds  of  germs,  among  which  there  is  the  same 
non-liquifying  toxicogenic  germ  found  in  the  well  water. 

Inoculation  Experiments. — Kind  of  animal  inoculated  with  the  germs: 
Rats.  Method  of  inoculation:  By  injection  into  the  peritonial  cavity. 
Kind,  amount,  and  age  of  culture  used:  Twenty  drops  of  a  beef-tea  cul- 
ture 24  hours  old.  Results  of  the  inoculation:  Death  with  all  the 
samples.  Post-mortem  appearances:  These  were  practically  the  same 
with  all  samples,  and  consisted  of  engorgement  of  the  spleen,  the  mesen- 
teric glands,  liver  and  kidney.  Description  of  the  germs,  if  any,  found  in 
the  organs:  The  toxicogenic  germs  found  in  the  waters  and  in  the  milk 
were  also  found  in  the  organs  of  the  animals.  In  what  organs  were  the 
germs,  if  any,  found  growing?     Spleen,  liver  and  kidney. 

Explanation. — One  drop  of  the  water  is  added  to  one  drachm  of  some 
culture  medium,  such  as  beef-tea,  and  this,  after  it  has  been  kept  at  the 
temperature  of  the  body  for  24  hours  or  longer,  is  used  for  inoculating 
animals. 

Conclusions. — I  regard  both  the  waters  and  the  milk  unsafe.  Of  the  two 
waters,  that  from  the  well  is  the  worse  both  chemically  and  bacteriologically. 
The  milk  was  examined  only  bacteriologically.  The  poison-producing 
germ  in  the  well  water  is  identical  with  that  in  the  milk.  I  am  inclined 
to  the  opinion  that  if  the  typhoid  fever  was  due  to  one  of  the  waters,  the 
well  water  is  the  one  more  likely  to  be  the  cause.  E berth's  germ  (the 
so-called  typhoid  germ)  was  not  found  in  any  of  the  samples.  This,  how- 
ever, does  not  mean,  in  my  opinion,  that  the  waters  would  not  cause  the 
typhoid  fever.  I  have  never  yet  found  Eberth's  germ  in  drinking  water 
(with  one  possible  exception).  The  river  water  probably  has  changed  in 
its  character  since  the  sample  was  taken,  but  the  well  water  certainly 
should  not  be  used. 

V.  0.  VAUGHAN, 

Director  of  the  Michigan  State  Laboratory  of  Hygiene. 
Ann  Arbor,  Nov.  12,  1890. 


218 


STATE  BOAKD   OF  HEALTH,— REPORT  OF  SECRETARY,  1891. 


TABLE  3. — Exhibiting  the  Localities  from  which  Typhoid  Fever  was  spread  {accord- 
ing to  the  official  reports),  with  the  number  of  Cases  and  Deaths,  if  reported;  the 
Secondary  Localities  into  which  the  Disease  was  said  to  have  been  Introduced  from 
the  First  {with  number  of  Cases  and  Deaths.)  Compiled  from  Reports  by  Health 
Officers  who  were  able  to  trace  the  source  of  Contagium  to  other  Localities. 


First  Localities  from  which 
Typhoid  Fever  Spread. 


In 
"First" 
Locahtles. 


Secondary  Localities  infected 
from  "  First." 


In 
'Secondary" 
Localities. 


Antrim  county: 
Torch  Lake  township. 


Baraga  county: 
Peqnaming,  L'Anse  township  , 

Berrien  connty: 
Berrien  Springs  village 


Calhoun  connty: 
Battle  Creek  city. 


Cass  county: 
Dowagic  city. 


Emmet  county: 
Petoskey  village. 

Gogebic  county: 
Bessemer  city 


Hillsdale  connty: 
North  Adams  township. 

Houghton  county: 
Calumet  village 


Ingham  connty: 
Stockbridge  village. 


Kent  connty: 
Grand  Rapids  city . 


Leelanaw  county: 
Empire  township . 

Lenawee  county: 
Adrian  city 


Lenawee  connty: 
Roliin  township 

Mecosta  county: 
Big  Rapids  city. 


Oscoda  county. 


Presque  Isle  county. 

St.  Clair  connty: 
St.  Clair  city 


193 


29 


5  Antrim  county: 

(     Central  Lake  township  . 

5  Houghton  connty: 

(     Lake  Linden  village 


5  Berrien  county: 

(     Berrien  township . 

f Calhoun  county: 
I      Beford  township.. 


I  BEirry  county : 

L    Barry  township. 

5  Van  Buren  county: 
i     Keeler  township 

( Lenawee  county: 
(     Morenci  village.. 


5  Ontonagon  county: 
I     Rockland  township. 

( Jackson  county: 

I     Liberty  township 


5  Ontonagon  county: 
(     Rockland  township. 


( Ingham  county: 

■J     Dansville  village.. 

(     Ingham  township  . 


r Allegan  county: 

I     Allegan  township. 

I  Kent  county : 

I     Cannon  township . 

L    Cascade  township. 


Leelanaw  county: 
Glen  Arbor  township.. 

Lenawee  county : 
Dover  township 


( Lenawee  county: 
(     Rome  township. 

5  Muskegon  county: 
1     Muskegon  city.. 


Sanilac  county: 
Marion  township . 


(  Cheboygan  county: 
(     Tuscarora  township 

5  St.  Clair  connty: 

(     Columbus  township 


*  This  outbreak  was  not  reported  to  this  office  by  the  Health  Officer  of  the  "  first "  locality  at  the  time 
it  occurred.    This  shows  neglect  in  the  locality  from  which  the  disease  spread. 


TYPHOID   FEVER  IN  MICHIGAN  IN  1890. 


219 


TABIiE  3. — CoNciAJDTET).— Exhibiting  the  Localities  from  which  Typhoid  Fever  was 

spread. 


Fii'St  Localities  from  which 
Typhoid  Fever  Spread. 


St.  Clair  connty: 
Port  Hnron  city. 


Wayne  connty: 
Detroit  city.. 


Adjoining  township. 


(Outside  the  State.) 


Canada . 


Chicago . 


Colorado 

Illinois 

Bardick,  Indiana 
Grarrett,  Indiana  .. 
Montana 


In 

"First" 

Localities. 


39 


10 


Secondax'y  Localities  infected 
from  "  First." 


(  Huron  connty: 

(     Verona  township. 

f Lenawee  connty: 
Morenci  village. . 


Macomb  county: 
Richmond  village. 
Romeo  villsige 


Oakland  county: 
Rose  township. 


Wayne  county: 
^    Hamtramck  township. 

5  Saginaw  county: 

/     Albee  township 


Tuscola  county: 
Gilford  township 


fKalamazoo  county: 

I     Schoolcraft  township. 

I  Macomb  connty: 

l_    Richmond  village 


Shiawassee  county: 
Perry  township.. 


Hillsdale  county: 
Ransom  township. 


Lenawee  county: 
Clayton  village. 

Lenawee  county: 
Morenci  village  . 


5  Livingston  county : 
(     Deerfield  township. 


In 
'Secondary'' 
Localities. 


*  This  outbreak  was  not  reported  to  this  office  by  the  Health  Officer  of  the  "  first  "  locality  at  the  time 
it  occurred.     This  shows  neglect  in  the  locality  from  which  the  disease  spread. 


In  the  following  instance  the  contagium  was  reported  to  have  been 
carried  to  a  third  locality: — 

From  Pequaming,  L'Anse  township,  Baraga  county  to  Lake  Linden 
village,-  Houghton  county,  thence  to  Torch  Lake  township,  Antrim  county. 

EFFORTS    FOR   THE    PREVENTION   AND   RESTRICTION   OF   TYPHOID   FEVER. 

It  is  gratifying  to  note  that  the  increased  interest  on  the  part  of  local 
health  officers  in  carrying  out  the  preventive  and  restrictive  measures 
recommended  by  the  State  Board  of  Health  in  outbreaks  of  typhoid  fever 
mentioned  in  the  Annual  Keport  of  this  Board  for  1890,  is  again  apparent 
this  year,  and  that  many  of  those  officials  have  been  very  zealous  in 
efforts  to  induce  physicians  to  report  cases  of  that  disease  occurring  in 


220        STATE  BOARD   OF  HEALTH.— REPORT  OF  SECRETARY,  1891. 

their  practice,  to  obtain  amelioration  of  the  water-supply  in  localities 
where  typhoid  fever  has  occurred,  and  in  advocating  the  introduction  of 
measures  calculated  to  improve  the  sanitary  conditions  in  their 
jurisdictions. 

The  following  extracts  from  letters  and  reports  received  at  this  office 
illustrate  the  nature  of  the  efforts  made  by  those  officials  and  show  that 
those  efforts  are  not  always  made  under  the  most  encouraging  or 
favorable  circumstances. 

"  I  am  doing  all  that  I  can  in.  the  way  of  disinfection  of  all  bowel  discharges,  cleanliness,  etc.  and 
whenever  I  can  prevail  upon  them  to  do  so,  I  have  all  drinking  water  boiled.  The  popnlation  is  largely 
foreign.  There  is  very  little  public  sentiment  in  favor  of  improvement,  and  only  a  small  minority  that 
will  givH  any  encouragement  or  cooperation  in  that  direction."— 4.  J.  Braden,  Health  Officer,  Baraga 
toivnship,  Baraga  county. 

"  Inclosed  please  find  final  report  of  those  cases  reported.  They  are  all  well  and  I  have  been  able  to 
make  the  owner  of  the  house  in  which  those  cases  were,  understand  that  it  was  his  duty  to  tear  the  house 
down.  The  house  is  old  and  is  built  on  saw  dust  which  has  been  there  for  years  and  which  would  surely 
canse  some  other  troubles  before  long.  I  have  found  out  that  years  ago,  about  four  or  five  years,  people 
living  in  the  same  house,  died  of  a  disease  not  recognized  then,  but  which  seems  to  me  to  be  the  same  as 
the  one  reported  as  typho-malarial."— JfeZi'iHe  E.  deLaval,  M.  D.,  Health  Officer,  Schoolcraft  township, 
Houghton  county. 

"  Drains  opened,  cleaned  and  disinfected.  Privy  vaults  cleaned.  Cellars  drained." — A.  J.  Braden, 
Health  Officer,  Baraga  toivnship,  Baraga  county. 

"  Your  enclosed  circular  and  other  documents  duly  received.  In  reply  would  say  that  we  have  had 
•eleven  cases  of  fever  in  this  location  this  year.  The  last  case  of  which  is  now  ready  to  be  returned  to  his 
home.  Our  fever  is  cared  for  here  in  our  hospital  by  experienced  nurses,  in  a  ward  devoted  exclusively 
to  their  use,  where  they  are  protected  from  officious  friends.  Their  diet  intelligently  administered,  the 
soiled  clothing  placed  in  disinfecting  fluid  on  the  same  floor,  the  sputa  received  in  sanitary  cups  and 
burned,  the  excreta  received  in  disinfecting  fluid  and  placed  in  barrels  at  remote  points  in  disinfecting 
fluid,  and,  next  month  when  frozen,  removed  beyond  possible  chance  of  communication.  As  the  season 
seemed  to  be  prolific  with  fever,  we  had  in  readiness  a  large  hall,  capable  of  holding  fifty  beds,  should 
our  hospital  be  overtaxed. 

"  Our  reason  for  caring  for  our  people  in  this  manner  is  due  to  the  fact,  that  since  1883  we  have  had  no 
case  of  fever  originate  in  our  location.  Previous  to  and  including  that  date,  fever  was  a  common  and 
•constant  visitor,  in  the  latter  year  reaching  eighty  cases.  Our  mining  officers  with  myself,  drafted 
sanitary  rules,  the  cleaning  of  wells,  ordering  garbage  and  slops  placed  in  pits  remote  from  the  welle, 
the  filling  and  disinfecting  of  vaults,  the  cleaning  of  cellars  under  the  rigid  daily  inspection  of  a  proper 
officer,  as  a  means  of  purifying  the  ground  surface  and  the  protection  of  our  water  supply  which  is  from 
the  surface  entirely.  Every  year  from  the  interchange  of  employes  coming  from  infected  districts,  we 
are  the  victims  of  transplantation  of  fever  and  for  the  avoidance  of  seed  sowing,  such  cases  are,  as  soon 
■as  discovered,  removed  where  the  details  of  restriction  can  be  carefully  carried  out,  and,  from  the  fact 
that  so  far,  in  the  time  named,  we  can  trace  the  neighboring  point  from  which  the  patient  came ;  and  that 
we  have  yet  to  record  a  case  as  being  infected  from  any  extension  of  the  disease,  speaks  plainly  the 
result  of  the  attention  given  it. 

"  We  have  no  municipal  organization  here,  all  measures  being  under  the  control  of  the  mining  com- 
pany, whose  representatives  are  the  township  officers,  and  I  cannot  too  highly  compliment  the  manager 
and  officers  of  the  mining  company  for  the  intelligent  and  cheerful  accord  by  which  is  made  possible  such 
sanitary  and  life-saving  methods."—/.  Freund,  21.  D.,  Health  Officer,  Champion  township,  Marquette 
county. 

DIFFICULTIES    EXPERIENCED    BY    LOCAL   HEALTH   OFFICERS   IN    RESTRICTING 

TYPHOID    FEVER. 

Some  of  the  difficulties  which  local  health  officers  experience  in  the 
performance  of  the  duties  required  of  them  by  law,  are  shown  by  the 
following  extracts  from  correspondence  of  this  office  with  those  health 
officers  in  regard  to  typhoid  fever: 


TYPHOID  FEVER  IN  MICHIGAN  IN  1890.  22  J 

Alvinza  C.  Merrill,  M.  D.,  Health  Officer  of  Harbor  Springs,  Emmet 
county,  reports,  relative  to  an  outbreak  of  typhoid  fever,  as  follows: — 

"  The  attending  physiciEin  did  not  inform  me,  nor  did  he  report  the  cases  to  me  as  he  shonld  have  done." 

In  reply  to  the  question  "What  exceptions  were  there  to  the  complete 
accomplishment  of  the  disinfection  of  excreta,  boiling  of  water,  etc.,"  in  an 
outbreak  of  typhoid  fever,  N.  D.  Lee,  M.  D.,  Health  Officer  of  Saginaw, 
West  side,  wrote: — 

"  None,  when  it  was  reported  by  a  physician;  bat  they  do  not  report  more  than  half  the  cases.  1  get 
more  than  half  of  the  cases  through  newspapers,  after  they  are  dead  or  well." 

F.  M.  Kerry,  Health  Officer  of  Benton  Harbor,  Berrien  county,  reported 
in  regard  to  an  outbreak  of  the  disease: — 

"  Three  families  were  reported  by  well  founded  rumor.  In  two  of  these  deaths  occurred.  The  physi- 
cians did  not  report  cases.  My  attention  would  be  called  to  the  fact  by  rumor  or  funeral  notice.  Physi- 
cians claimed  disease  was  typho-malarial  or  bilious  remittent  fever. 

"  Have  not  had  a  case  of  typhoid  reported  to  me  by  a  physician." 

N.  B.  Sherman,  M.  D.,  Health  Officer,  Waterloo  township,  Jackson 
county,  reporting  in  regard  to  typhoid  fever,  wrote: — 

"  I  have  learned  in  a  casual  way  of  the  death  of  Jas.  Kowe,  Mrs.  Hall,  and  Henry  Arty.  The  attending 
physicians  were  Dr.  Rowe,  of  Stockbridge;  Dr.  Condon,  Munith;  Dr.  Raymond,  Grass  Lake.  These  cases 
have  not  been  reported  to  me.  *  *  *  *  Possibly  these  Drs.  before  mentioned  do  not  understand  their 
duty." 

In  studying  the  effects  of  efforts  of  health  officers  for  the  restriction  and 
prevention  of  typhoid  fever,  and  of  the  difficulties  experienced  by  some  of 
them  in  carrying  out  the  methods  recommended  by  the  State  Board  of 
Health  to  that  end;  it  is  interesting  to  note  the  difference  in  the  reported 
numbers  of  cases  of  sickness  and  of  deaths,  from  this  disease,  in  outbreaks 
where  local  health  officers  were  enabled  to  enforce  isolation  and  disinfec- 
tion, and  in  those  outbreaks  in  which,  for  any  reason,  those  restrictive 
measures  were  neglected. 

The  diagram  on  page  222  graphically  illustrates  this  difference,  and 
shows  that  in  outbreaks  relative  to  which  the  reports  state  that  isolation 
and  disinfection  were  enforced,  there  occurred  1.97  cases  and  0.32  of  one 
death  per  outbreak;  whereas  in  those  outbreaks  where  isolation  and  disin- 
fection were  neglected,  there  were  6.58  cases  of  sickness  and  0.96  of  one 
death  per  outbreak;  or  about  three  times  as  many  cases  and  deaths  in  out- 
breaks in  which  isolation  and  disinfection  were  neglected,  as  there  were  in 
outbreaks  where  those  restrictive "  measures  were  enforced.  It  therefore 
seems  probable  that  if  proper  restrictive  measures  had  been  adopted  in  all 
the  330  outbreaks  of  this  disease  which  were  reported  to  this  office  during 
the  year,  with  results  similar  to  those  obtained  in  the  above-mentioned 
outbreaks  where  isolation  and  disinfection  were  enforced  (1.97  cases  and 
0.32  of  one  death  per  outbreak),  there  would  have  occurred  only  650  c^-ses 
of  sickness  and  106  deaths  from  this  disease  in  the  State  during  the  year, 
instead  of  the  1,924  cases  and  304  deaths  which  actually  occurred  in  those 
outbreaks  which  were  reported;  and  a  saving  to  the  State  of  1,274 
cases  of  sickness  and  198  lives  would  have  been  effected. 

This  showing  seems  to  present  a  forcible  argument  in  favor  of  the  adop- 
tion of  the  preventive  measures  above  referred  to,  and  a  strong  plea  for 
the  cooperation  of  all  the  people,  in  the  efforts  of  health  officers  to  stamp 
out  this  preventable  disease. 


222        STATE   BOARD   OF  HEALTH.— REPORT  OF  SECRETARY,  1891. 
ISOLATION   AND    DISINFECTION   RESTRICT   TYPHOID   FEVEE. 


^y^hoid^euer'mtMichigran  in  /S90:-Sxhibitiv^  the  a^er-^ 
age  numbers  of  cases  and  deaths  yf:>er  outbreak:- in  all  out- 
breaks in  uuhlch  isolation  and  disinfeciion  u/ere  both  negr- 
leefed'f  and  in  all  oatbyeakj  in  whick  both  ujere  enforced. 
(CoYn^iled  IK  the  office  of  the  Secyetary  of  the  Jtate  Board 
of  Health,  from  reports  made  lu  local  health  officers-  ) 

— _| _ . — 1 ^ . . 1 . ^J^ _ 


isolation  and  disinfection 

e  nf  o  rceoL. 


^?7cluding  the  disinfeeiion  of  iJhe  bowel  discharges  of 
the   foaticnis  , 


TYPHOID  FEVER  IN  MICHIGAN  IN  1890. 


223 


AYEEAGE  DUKATION  OF  TYPHOID  FEVEE.  -  FATAL  AND  NON-FATAL  CASES. 


Table  4. — Exhibiting  by  Sex  of  patient,  the  Average  Duration  {in  days)  of  Fatal 
cases  of  sickness  from  Tyi^hoid  Fever,  in  Michigan,  during  the  four  years,  and  dur- 
ing each  of  the  four  years  1881-90.  {Compiled  from  those  reports  which  stated  the 
length  of  time  the  patient  was  sick.) 


00 

Fatal  cases  of  Typhoid  Fever. 

S.2 

=  -5.2 
d.S5 

Duration  of  Sickness:— Per  cent  of  Deaths  in  each       | 
Period  of  Days. 

<° 

Co 

o 

i 

i 

o 

o 

O 

i 

s 

o 
1 

1§§ 

Males ... 

81 
32 

100 
100 

10 
31 

7 
19 

15 
19 

21 
16 

16 
6 

11 
3 

12 
0 

2 
0 

4 

6 

1 

0 

0 
0 

Females .    .. 

X 

00 

Males 

40 
33 

100 
100 

20 
24 

13 
21 

18 

'1 

10 

9 

8 
6 

0 
3 

5 
0 

3 
0 

3 
9 

0 

0 

Females ... 

15 

12 

00 

00 

Males 

42 
51 

100 

loe 

17 

18 

14 

24 

19 
14 

7 
16 

14 
10 

5 
2 

7 
6 

2 
2 

7 
2 

0 
0 

7 
8 

Females.  .. . 

© 

00 

1-1 

Males . 

57 
26 

100 
100 

19 
19 

9 
23 

21 

8 

23 

8 

5 
19 

5 

12 

7 
0 

0 

8 

4 

0 

2 
0 

4 

Females 

6 

Males 

220 
142 

100 
100 

17 

23 

11 

22 

18 

14 

19 
IS 

11 
11 

7 
6 

5 
2 

2 
3 

5 

2 

2 
2 

3 
3 

Females... 

From  Table  4  it  may  be  seen  that  of  the  220  males  who  were  reported 
to  have  died  from  typhoid  fever  -within  the  four  years  1887-90,  and  of 
which  the  interval  between  the  day  of  being  taken  sick  and  day  of  death 
was  given,  the  largest  per  cent  died  in  the  two  periods  from  the  15th  to 
the  20th  and  from  the  20th  to  the  25th  day  of  sickness,  and  that  54  per 
cent  were  sick  twenty  or  more  days  before  they  died;  while  of  the  142 
females  reported  as  having  died  in  the  same  time,  23  per  cent  died  before 
the  tenth  day,  and  that  only  42  per  cent  were  sick  longer  than  nineteen 
days. 

The  average  duration  for  the  fatal  cases,  was  in  males  22.4  days,  and 
in  females  20  days. 

In  Table  5  it  may  be  noticed  that  the  duration  of  sickness  in  non-fatal 
cases  of  typhoid  fever  for  the  four  years,  1887-90,  was  about  the  sanae  for 
both  sexes;  62  per  cent  of  the  males  and  64  per  cent  of  the  females 
recovered  before  the  thirty-fifth  day  of  sickness.  The  average  duration 
was: — males  32.8  days,  females  31.5  days. 

The  average  duration  of  all  cases,  fatal  and  non-fatal,  was:  —males,  27.6 
days,  females,  25.8  days;  and  for  all  cases  of  both  sexes,  26.87  days. 


224 


STATE  BOAKD  OF  HEALTH.-REPORT  OF  SECRETARY,  1891. 


TABLE  5. — Exhibiting  by  Sex  of  patient,  by  per  cent  of  cases  which  recovered  in 
specified  periods  of  time,  the  average  duration  {in  days)  of  non-fatal  cases  of  sick- 
ness from  Typhoid  fever,  in  Michigan,  during  the  four  years  and  during  each  of 
the  four  years  1887-90.  {Compiled  from  those  reports  which  stated  the  length  of 
time  the  patient  was  sick.) 


u 

Non-Fatal  Cases  of  Typhoid 
Fever. 

11 

OT3-5 

0-35 

Daration  of  Sickness: — Per  Cent  of  Cases  in 
Period  of  Days. 

each 

n 
CM 

0 

S 

o 

s 

0 

1 

d 
0 

s 

o 

d 

1 

s 

o 

II 

s 

2 

Males 

203 
158 

100 
100 

0 
0 

5 
9 

4 

2 

6 
9 

13 

7 

12 

19 

9 
11 

16 
12 

13 
15 

18 
17 

15 
15 

15 
11 

9 
19 

9 
6 

10 

4 

6 
4 

9 

8 

3 
3 

9 
10 

8 
9 

7 
8 

X 
X- 
X 

Males.    _ 

164 
111 

100 
100 

1 

0 

Females..      .           ....        

05 
X 
X 

Males     -.  ...    

166 
165 

100 
100 

2 
6 

7 
8 

13 

9 

14 
14 

16 
19 

14 

12 

12 
11 

9 

8 

6 

4 

2 
2 

5 
7 

Females ..                           .... 

© 

S5 
X 

Males 

Females .. 

226 
110 

100 
100 

1 
1 

4 
4 

7 
14 

15 
16 

18 
17 

19 
13 

12 
14 

10 
9 

5 
2 

2 
5 

8 
6 

o 
•«ijx 

X 

Males                               .. 

759 
544 

100 
100 

1 

2 

5 
6 

10 
10 

13 

16 

16 
16 

17 

14 

12 
14 

io 

7 

7 
5 

4 

5 

7 
8 

Females 

TABLE  6. — Exhibiting,  by  Sex  of  patient,  the  Age  of  persons  reported  sick  from 
Typhoid  Fever,  in  Michigan,  duriny  each  of  the  four  years,  1887-90,  and  the  aver- 
ages for  the  four  years.  Also  the  Average  Age,  and  the  Number  of  cases,  in  which 
the  age  was  stated,  reported  in  each  of  the  four  years.  {Compiled  from  reports  of 
those  cases  in  which  the  Age  was  stated.) 


(B 

Sickness  from  Typhoid 
Fever. 

6 

o  a-d 

Age, 

—In  periods  of  Years.    Per  Cent  of  Cases  in 
each  Period  of  Age. 

i 

< 

o 

0 

o 

s 

0 

§ 

s 

IS 

m 

8 

5" 
S 

s 

g 

3 

in 

si 
g* 

1^ 
X 

X 

Males       .      .                -  

24 
22 

316 
245 

100 
100 

10 
17 

10 
10 

14 
20 

20 
15 

17 
10 

9 
10 

8 
5 

4 
4 

2 
3 

4 

5 

Females 

QO 
X 
X 

Males                                   . 

24 
23 

310 
199 

100 
100 

12 

12 

13 
22 

15 

20 

20 
14 

11 

8 

11 

5 

5 
4 

4 
6 

3 
3 

6 

7 

S5 
X 
X 

Males ...  .. 

24 
23 

362 
310 

100 
100 

13 
16 

11 
17 

17 
20 

25 
12 

10 

8 

8 

7 

6 

7 

3 

4 

2 
4 

6 
5 

© 

as 

X- 

Males — . 

22 
20 

325 
199 

100 
100 

14 

16 

12 

16 

16 

24 

25 
17 

16 
11 

7 
6 

4 
5 

3 
1 

2 
2 

3 
4 

Females..           .  

© 
■^x 

X 

Males 

24 

22 

1,313 

953 

100 

100 

12 

15 

12 

16 

16 
21 

23 
15 

14 

9 

9 

7 

6 
5 

4 
4 

2 
3 

5 
5 

Females 

TYPHOID  FEVER  IN  MICHIGAN  IN  1890.  225 

AGE   OF   OCCUREENCE   OF   TYPHOID   FEVER. 

In  studying  table  6  relative  to  age  of  persons  who  have  typhoid  fever,  it 
should  be  borne  in  mind  that  there  are  more  persons  living  at  the  earlier 
ages  than  at  the  more  advanced  ages.  After  the  publication  of  the  census 
of  1890,  it  will  be  possible  to  compare  this  table  with  one  exhibiting  the 
per  cent  of  persons  living  in  each  period  of  age,  and  thus  complete  the 
study  here  provided  for  by  this  statement  of  facts  relative  to  nearly  two 
thousand  three  hundred  cases  of  typhoid  fever. 

TWO   LINES   OF   EVIDENCE   OF   THE   PREVALENCE   OF   TYPHOID   FEVER. 

In  studying  the  prevalence  of  typhoid  fever  in  1890,  from  the  facts  pre- 
sented in  the  preceding  and  following  pages,  it  must  be  borne  in  mind 
that  those  facts  are  derived  from  two  distinct  sources  of  information : 

1. — The  numbers  of  outbreaks,  of  cases  of  sickness,  and  of  deaths  from 
typhoid  fever  are  taken  from  special  reports  from  health  officers  and  other 
township,  city  and  village  officers,  during  the  course  of  an  outbreak,  at  its 
close,  or  in  spe^^ial  reports  at  the  close  of  the  year.  If  all  the  people  and 
officers  reported  as  the  laws  provide,  the  facts  presented  would  represent 
the  actual  numbers  of  outbreaks,  cases  of  sickness,  and  deaths  from 
typhoid  fever  which  occurred  in  the  State  during  the  year;  but  all 
do  not  so  report.  It  is  just,  however,  to  state  that,  as  the  people  generally 
are  becoming  better  instructed  in  the  measures  recommended  by  the  State 
Board  of  Health  for  the  saving  of  life  and  health,  better  and  more  com- 
plete reports  are  made  year  by  year.  So,  each  year,  we  believe  that  an 
increasing  proportion  of  the  cases  of  sickness  and  deaths  from  the  danger- 
ous communicable  diseases  are  reported  to  this  office.  This  tends  towards 
an  apparent  increase  in  the  prevalence  of  the  disease  each  year,  modified, 
of  course,  by  the  real  fluctuation  in  prevalence.  While  waiting  for  perfect 
reports,  the  facts  derived  from  those  now  received  are  valuable  for  purposes 
of  study. 

2. — The  prevalence  of  typhoid  fever,  or  of  any  given  disease,  as  indicated 
by  the  "  per  cent  of  reports  "  is  taken  from  the  weekly  postal-card  reports 
from  regular  correspondents  of  the  State  Board,  health  officers  of  cities 
and  villages,  and  others.  The  "  per  cent  of  reports  "  is  the  per  cent  of  the 
whole  number  of  reports  received  which  stated  the  presence  of  the  disease 
named;  it  gives  the  relative  prevalence  of  the  disease,  under  the  observa- 
tion of  the  physicians  who  report.  It  may  represent  the  relative  area  of 
prevalence  of  the  disease,  combined  with  the  relative  number  of  weeks  the 
disease  continued  where  it  did  occur,  hut  not  the  actual  number  of  cases. 
29 


226       STATE  BOARD   OF  HEALTH.— REPORT  OF  SECRETARY,  1891. 


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TYPHOID  FEVER  IN  MICHIGAN  IN   1890. 


227 


The  weekly  card  reports,  however,  furnish  a  valuable  means  of  ascertain- 
ing, approximately,  the  relative  prevalence  of  the  several  diseases  in  a 
given  year,  and  the  relative  prevalence  of  a  given  disease  in  one  year  com- 
pared with  other  years,  and  it  is  as  good  a  scheme  for  ascertaining  the  facts 
as  is  yet  available.  Therefore  the  sickness  statistics  based  upon  those 
weekly  card-reports  should  be  relied  upon  for  a  comparison  of  the  relative 
prevalence  of  typhoid  fever  in  1890  compared  with  preceding  years.  How- 
ever, the  evidence  from  the  two  sources  may  well  be  compared. 

A  comparison  of  the  evidence  from  the  two  sources,  just  mentioned, 
relative  to  typhoid  fever  during  the  years  1886-90,  is  facilitated  by  the 
following  Exhibit  1: — 

Exhibit  1. — By  years  for  the  Six  Years  1885-90,  the  Per  cent  of  Reports  {from 
regular  correspondents  to  the  State  Board  of  Health,  and  others)  Stating  the 
Presence  of  Typhoid  Fever  in  Michigan,  also  the  numbers  of  Outbreaks,  numbers  of 
Localities  of  Outbreaks,  the  Cases  of  Sickness  and  the  Deaths  from  Typhoid  Fever 
for  the  Same  Years. 


Years. 

Per  cent  of 

Weekly  postal 

Reports 

Stating  the 

Presence  of 

Typhoid  feTer. 

Reported 

Ontbreake  of 

Typhoid 

fever. 

Reported 

Localities  of 

Ontbreaks 

of  Typhoid 

fever. 

Reported 

Cases  of 

Sickness  from 

Typhoid  fever. 

Reported 

Deaths  from 

Typhoid 

feVer. 

1885 -- 

t 
8 

8 

10 

10 

10 

8 

218 
290 
335 
316 
432 
330 

200 
282 
320 
296 
398 
310 

715 
1,194 
2,424 
*1,511 
2,530 
1,924 

194 
282 
411 
310 
402 
304 

1886.. 

1887 -. 

1888 

1889. 

1890...   . 

*  Inasmnch  as  it  appears  that  the  reported  ontbreaks  and  localities  in  which  typhoid  fever  occurred  in 
1888  v^ere  not  very  much  less  than  in  the  preceding  year,  and  were  even  more  than  in  the  year  1886,  it  is 
possible  that  in  1888,  the  ontbreaks  of  typhoid  fever  were  not  allowed  to  spread  as  much  as  in  previous 
years. 


THE    RELATION   OF   SICKNESS   FROM     TYPHOID   FEVER   TO    THE   RAINFALL,    TO 

THE   GROUND   WATER,t  AND   TO   THE   HEIGHT   OF   THE 

WATER   IN   WELLS,    IN   MICHIGAN. 

Typhoid  fever  differs  in  its  mode  of  spread  from  some  of  the  other  dan- 
gerous communicable  diseases.  It  is  now  most  generally  believed  to  be 
spread  by  a  specific  "  germ,"  which  is  reproduced  in  the  intestines,  being 
conveyed  from  the  bowel  discharges  of  a  victim  of  the  disease  to  the 
alimentary  canal  of  the  second  victim.  Probably  the  most  usual  mode  of 
conveyance  for  these  "  germs  "  is  the  contamination  of  the  water-supplies 
by  the  fecal  matter  from  those  sick  with  this  disease.  The  contamination 
of  the  water-supplies,  and  the  virulence  of  the  infected  water  seem  to 
depend  largely  on  the  amount  of  rainfall  and  the  consequent  amount  of 
water  in  wells  which  supply  water  for  culinary  and  drinking  purposes.  A 
discussion  of  this  subject  from  the  evidence  then  collected,  was  printed  in 
the  Keport  of  this  Board  for  the  year  1884,  pages  88-114.  Further  evi- 
dence has  been  collected  and  is  presented  in  the  following  tables. 

t  It  now  appears  that  the  fluctuations  in  the  level  of  the  water  in  the  wells  from  which  water  is  drawn 
daily  are  not  the  same  as  in  wells  from  which  no  water  is  drawn,  and  which,  therefore,  show  more 
accurately  the  level  of  the  ground  water. 


228       STATE  BOARD  OF  HEALTH.— REPORT  OF  SECRETARY,  1891. 

TABTiE  8. — Typhoid  Fever  in  Michigan. — Average  per  cent  of  weekly  card-reports 
stating  the  presence  of  Typhoid  Fever,  by  year  and  Months  for  the  Ten  years,  1878- 
87,  also  in  each  of  the  six  years,  1885-90. 


Period  of  Time. 

Year. 

1 
Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

■ 

Dec. 

Av.  10  yrs..  1878-87*- 
1885.. 

12 

t8 

18 

10 

10 

10 

8 
1 

10 
11 

6 
6 
10 
8 
6 

9 
7 
3 

10 
7 
5 
1 

7 
5 
4 
i 
6 
3 
2 

5 
4 
3 
3 

5 
3 

2 

5 
3 

5 
3 

4 

4 
2 

5 
5 
4 
4 
5 
5 
5 

7 
5 
5 
8 
7 
5 
6 

14 
6 
13 
14 
12 
12 
1.5 

20 
11 
16 
22 
18 
19 
15 

22 
13 
16 
18 
16 
25 
16 

20 
16 
13 
15 
12 
19 

n 

14 

8 
10 
11 
10 
12 

7 

1886 . 

1887*..    

1888.-             .      .     .. 

1889 

1890.. 

*  The  figrwee  in  the  line  for  1887,  and  in  the  Une  for  the  average  for  the  ten  years  1878-87,  in  this  table  do 
not  all  exactly  agree  with  those  in  the  same  lines  in  the  table  printed  on  page  Ivi,  of  the  Report  of  this 
Board  for  the  year  1888,  for  the  reason  that  the  table  printed  in  the  Report  for  1888  was  made  before  the 
cards  were  all  compiled  for  the  year  and  was  taken  from  the  compilation  (of  the  card  reports  first 
received)  for  the  quarterly  reports.  The  line  "  Average  10  years  1878-87,"  inclnded  the  data  for  the  year 
1887  and  consequently  is  not  exactly,  although  it  is  substantially,  the  same  as  in  the  above  table. 

t  Since  May,  1885,  physicians  have  reported  only  the  prevalence  of  diseases  under  their  own  observation. 
Previous  to  that  time  diseases  which  were  believed  to  be  present  (under  the  care  of  other  physicians)  were 
BO  reported.  This  undoubtedly  accounts  for  a  part  of  the  sudden  decrease  in  1885  and  1888  as  compared 
with  the  preceding  years. 

Table  8  exhibits  the  average  prevalence  of  typhoid  fever  in  Michigan  by 
year  and  months  for  the  ten  years  1878-87,  and  for  each  of  the  six  years, 
1885-90,  as  indicated  by  the  weekly  card  reports  made  by  regular 
observers.  Table  9  exhibits  the  rainfall  by  months  and  years  for  the 
period  of  ten  years,  1878-87,  and  for  each  of  the  six  years  1 885-90. 

TABLE  9. — Rainfall  in  Michigan. — Average  number  of  Inches,  by  Months,  for  tfie 
Ten  Years  1878-87,  also  in  each  of  the  six  years,  1885-90. 


Period  of  Time. 

Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Av.  10  yrs,  1878-87... 
1885 

37.27 
35.82 
32.16 
29.82 
29.55 
28.18 
30.20 

2.09 
2.70 
3.05 
2.27 
1.99 
2.42 
3.53 

2.89 
.73 
1.72 
4.47 
1.77 
2.04 
2.40 

2.28 
.58 
2.74 
1.18 
2.51 
1.01 
2.12 

2.49 
2.47 
2.40 
1.54 
2.15 
1.62 
8.37 

3.52 
2.30 
2.58 
2,25 
3.73 
4.21 
4.80 

4.24 
6.01 
2.29 
2.76 
2.87 
3.82 
3.74 

3.44 
2.52 
1.36 
2.46 
2.02 
3.07 
1.47 

3.21 

5.82 
4.21 
1.98 
2.38 
.98 
3.63 

3.72 
3.75 
5.36 
2.84 
2.66 
1.85 
2.09 

3.45 
3.08 
1.97 
2.48 
2.68 
1.10 
4.97 

2.98 
2.90 
2.35 
2.10 
2.92 
3.10 
2.43 

2.69 
2.14 
2.13 
2.55 
1.89 
2.96 
1,70 

1886 

1887    . 

1888 

1889 

1890. 

Table  10  exhibits  the  relation  of  low  water  in  wells  to  sickness  (as  shown 
by  the  weekly  card  reports)  and  the  reported  deaths  from  typhoid  fever  in 
Michigan,  for  the  twelve  years,  1878,  1880-90.  The  facts  presented  in  two 
lines  of  this  table,  low  water  in  wells  and  sickness  from  typhoid  fever,  for 
a  ten  year  period,  are  graphically  represented  in  a  diagram  on  page  256  of 
the  Annual  Report  of  this  Board  for  1889. 

The  diagram,  on  page  229  of  this  Report,  graphically  represents  the 
relation  of  the  sickness  from  typhoid  fever,  to  the  rise  and  fall  of  the 
water  in  wells,  in  Michigan,  for  the  twelve-year  period  comprising  the 
years  1878  and  1880-90. 


TYPHOID  FEVER  IN  MICHIGAN  IN  1890. 


229 


MICIIIGA.N      SIaFF     ^'j\P.3      or      HFALTH      tXHiBIT.v 

LOW   WATER   IN   WELLS,  AND  SICKNESS  FROM  TYPHOID  FEVERJN  MICHIGAN. 


-.    %  menlhsjcr  a.  period  of  /li^ears,   J  hi  and  lHO-^Oj 

ihe  relation  cf  Sickness  Jrcjn 

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lean.  (  Jhe  depth  of  ihe 

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<§ 

water  In  wells,  and  ihe  de^th  cf  earth  above    ihe  water  u/at  rc-pcrled  '6i^  obserpers 

?  5 
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Jittnenjnm  Tupkcid  Fever _., Ground    Water 


Hndicetin^  uhaiperetnl^all  refioris  receii^ed  Hated  the /bresenee  of  Jut  hold  Jhuer  then  under  the  cttser^'a. 
Uon  q  the  finyjtetans  rthcrling  ^    -yi 


im  Uii  dtayrdm  . 

i^kn  Uert  rrt  Hi  mtrt  '/nc/kti 


230       STATE  BOARD   OF  HEALTH.— REPORT   OF  SECRETARY,  1891. 

Comprehensive  study  of  this  subject  was  made  by  the  Secretary  of  this- 
Board  in  a  paper  read  before  the  American  Public  Health  Association,  at 
St.  Louis,  Mo.,  Oct.  16,  1884,  which  was  printed  in  the  Annual  Report  of 
this  Board  for  the  year  1884,  pp.  89-114,  and  the  study  was  continued 
subsequently,  in  the  Annual  Reports  of  this  Board  for  the  years  1888,  pp. 
Iv-lvii;  1889,  pp.  254-262;  1890,  pp.  247-251. 

The  evidence  is  conclusive  that  there  is  a  necessary  relation  between  the 
low  water  in  wells  and  the  sickness  from  typhoid  fever. 


TABLE  10.— Exhibiting,  for  Michigan,  by  Months,  during  the  Twelve  Years,  1878, 
1880-1890,*  the  Relation  of  Low  Water  in  Wells  to  Sickness  from  Typhoid  Fever; 
also,  the  Reported  Number  of  Deaths  from  Typhoid  Fever. 


Month. 


Av,  inches  of  ground  above 
the  water  in  wellsf -  - 

Flnctnation  from  Max. 
Depth  of  water  in  wells.. 

Sickness  from  Typhoid 
fever:{ 

At.  number  of  reported 
deaths  from  Typhoid 
feveril 


Jan. 

reb. 

Mar. 

April. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

NOY^ 

Dec. 

200 

195 

191 

188 

183 

186 

202 

209 

215 

220 

215 

212 

17 

12 

8 

0 

0 

3 

19 

26 

32 

37 

32 

29 

10 

8 

6 

5 

5 

5 

7 

13 

19 

21 

18 

13 

24 

21 

24 

25 

24 

22 

27 

58 

92 

101 

72 

54 

*  The  data  relating  to  the  sickness  and  the  deaths  from  typhoid  fever  in  the  years  1878, 1880-90,  were  used 
in  order  to  coincide  with  the  same  period  for  which  the  measurements  of  ground  above  the  water  in  wells 
were  already  obtained. 

t  The  year  1879  could  not  be  included  as,  for  that  year,  there  was  no  station  from  which  reports  were 
received  for  the  whole  year.  The  stations  used  in  the  compilation  of  this  line,  and  the  years  for  which 
reports  were  received  and  compiled  from  each  are  as  follows:  Elsie,  1878;  Thornville,  1880-1  and  1885-7 ; 
Hillsdale,  1880,  1884,  1887-90;  Mendon  and  Union  City,  1880;  Linden  and  Dearborn,  1881;  Brockway 
Center,  1882  and  1883 :  Otisville  and  Woodland,  1882;  Saginaw  City,  1883;  Kalamazoo,  1884, 1888  and  1889 ; 
Lansing,  8.  B.  of  H.,  1885-90;  Ann  Arbor  and  River  Raisin,  1886-90;  Alpena,  1887-88;  Otsego,  1887;  Traverse 
City,  1888-90;  Battle  Creek,  1888, 

t  Per  cent  of  weekly  reports,  from  observers  in  different  parts  of  the  State,  which  stated  the  presence  of 
typhoid  fever. 

II  The  data  used  in  the  compilation  of  this  line  were  taken  from  the  Registration  Reports  of  Michigan. — 
Vital  Statistics. 


From  January  to  May  the  fluctuations  in  the  sickness  from  typhoid 
fever  and  the  depth  of  the  water  in  wells  are  nearly  coincident.  In  June 
the  increase  in  the  sickness  follows  the  decrease  of  the  water  with  an  inter- 
val of  about  a  month.  Thence  during  the  rest  of  the  year,  the  agreement 
of  the  two  is  very  close.  The  maximum  of  sickness  and  the  minimum  of 
water  are  coincident  in  October. 

The  stations  at  which  the  measurements  of  water  in  wells  are  taken  and 
the  number  of  years  which  are  available  from  each  station  are  stated  in  the 
dagger  (f)  footnote  at  the  bottom  of  Table  10,  this  page.  The  Office  has 
been  unai3le  thus  far  to  get  accurate  measurements  of  the  height  of  water 
in  wells  for  a  long  period  of  years  from  any  stations  in  Michigan.  This 
absence  of  extensive  data  is  especially  deplored  when  a  comparison  of  one 
year  with  a  series  of  years  is  desired,  but  in  the  averages  for  a  series  of 
years  by  months,  the  evidence  is  accurate  and  valuable. 

It  is  believed  that  all  the  wells  from  which  measurements  of  water  are 
made  for  this  office,  except  the  well  at  Lansing,  are  used.  The  well  at 
Lansing  is  in  the  capitol  grounds,  far  enough  from  other  wells  so  as  not  to 


TYPHOID  FEVER  IN  MICHIGAN   IX  1890. 


231 


be  liable  to  be  affected  by  tbe  rise  and  fall  of  the  water  in  other  wells  from 
daily  use,  and  so  would  more  nearly  represent  the  gradual  rise  and  fall  of 
the  ground  water  than  would  measurements  in  wells  from  which  water  is 
drawn.  But  it  has  been  found,  by  long-continued  observations  and  investi- 
gations, that  the  rise  and  fall  of  the  typhoid  fever  is  in  much  closer  rela- 
tion to  the  fall  and  rise  of  the  water  in  wells  in  actual  use  than  to  the 
fluctuations  in  the  well  at  Lansing. 


TABLE  11. — Ground  Water. — Inches  of  Earth  above  the  Water— by  Months  for  the 
six  years,  1885-90,  and  for  the  Ittst  four  months  of  the  year  1884,  and  for  each  of  the 
six  years,  1885-90,  at  Lansing-,  Mich., —  Well  in  the  Capitol  Ch'ounds. 


Period  of  time. 

Year, 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

1885-90 

292 

293 

294 

292 


289 

289 

288 

290 

291 

293 

290 
282 
287 
291 
293 
305 
300 

295 
291 
285 
286 
294 
297 
308 
300 

295 
293 
281 
291 
297 
294 
311 
298 

297 
292 
280 
294 
294 
300 
312 
300 

1884 

1885 

284 
281 
290 
294 
304 
300 

288 
276 
296 
292 
298 
309 

289 
278 
287 
298 
304 
307 

292 
274 
280 
294 
304 
305 

280 
272 
282 
293 
302 
302 

281 
273 
285 
293 
304 
296 

279 
277 
288 
293 
299 
292 

282 
282 
290 
293 
299 
293 

283 
287 
291 
290 
302 
295 

1886 

1887   .   

1888 — 

1889 

1890    

Table  11  exhibits  the  height  of  ground  above  the  water  in  the  well  at 
Lansing,  by  months  and  year  for  the  six  years,  1885-90.  In  table  13  the 
first  line  of  table  11  is  used,  with  the  average  line  in  the  following  table 
(12),  together  with  the  average  sickness  from  typhoid  fever  during  the 
same  years. 


TABLE  12. — Temperature  of  the  Water  in  the  Well  at  the  State  Capitol  in  Lansing, 
Mich.,  by  Months  for  the  Six  Years,  1885-90,  and  the  last  four  months  of  the  year 

1884. 


Year  and  period  of 
years. 

Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

At.  Six  Y're,  1885-90. 

49 

50 

47 

46 

46 

48 

48 

48 

50 

51 

51 

52 

50 

1884 

50 
50 
52 
50 
51 
50 
51 

51 
50 
52 
51 
51 
51 
51 

51 
51 
51 

52 
52 
51 
52 

49 
45 
50 
51 
51 
51 
51 

1885 

47 
48 
48 
49 
50 
50 

49 
49 
50 
50 
50 
50 

47 

47 
41 
49 
49 
49 

43 
46 

42 
48 
49 
49 

42 
45 
46 
47 

48 

48 

46 
46 

47 
48 
49 
49 

48 
46 
48 
48 
49 
49 

47 

47 
49 
47 
50 
49 

48 
50 
51 
50 
50 
50 

1886 

1887 

1888 

1889. 

1890. 

232       STATE  BOARD  OF  HEALTH.— REPORT  OF  SECRETARY,  1891. 

TABLE  13. — Sickness  from  Typhoid  Fever  in  Michigan  {as  indicated  by  the  Weekly 
Card  Reports  by  all  Observers)  and  the  depth  of  Earth  {in  inches)  above  the  Water 
in  the  Well,  and  the  temperature  of  the  water  in  the  Well,  at  Lansing,  Michigan, 
by  Year  and  Months  for  the  Six  Years,  1885-90. 


Year. 

Jan. 

Feb. 

Mar. 

Apr. 

May. 

June. 

July. 

Aug. 

Sept. 

Oct. 

Nov. 

Dec. 

Sickness  from   Tyhoid 
rever  * 

9 

8 

6 

4 

3 

4 

5 

6 

12 

17 

17 

15 

10 

Inches  of  Earth  above 
Water  In  Well 

292 

293 

294 

292 

289 

289 

288 

290 

291 

293 

295 

295 

297 

Temperature  of  water 
In  WeU.. 

49 

50 

47 

46 

46 

48 

48 

48 

50 

51 

51 

52 

50 

*  Per  cent  of  all  reports  received  (from  observers  in  different  parts  of  the  State)  which  stated  th& 
presence  of  typhoid  fever. 

♦ 

From  table  13  it  may  be  seen  tliat  the  relation  of  sickness  from  typhoid 
fever  to  the  ground  water,  as  represented  by  the  depth  of  water  in  the  well 
at  Lansing,  is  not  so  close  as  that  which  is  shown  to  exist  between  sickness 
from  typhoid  fever  and  low  water  in  wells  in  Table  10,  on  page  230  of  this 
report.  It  is  still  possible,  however,  that  if  we  could  obtain  measurements 
of  water  in  unused  wells  in  the  different  localities  whence  the  reports  of 
typhoid  fever  are  derived,  or  could  we  have  a  full  and  correct  report  of  all 
cases  of  the  disease  which  occurred  in  Lansing  during  the  same  period 
for  which  we  have  measurements  of  the  well  there,  and  before  there  was  a 
general  water  supply  in  Lansing,  comparison  of  those  data  might  show  the 
existence  of  as  close  affinity  between  low  Ground-water  and  typoid  fever, 
as  exists  between  typhoid  and  low  water  in  wells. 


TABLE  14. — Exhibiting  the  Average  Total  Annual  Rainfall  at  Stations  in  Michigan, 
the  same  for  Lansing,  the  inches  of  Earth  above  the  Ground  Water  at  Lansing, 
the  Inches  of  Water  in  an  undisturbed  Well  at  Lansing,  and  the  Reported  Sickness 
from  Typhoid  Fever  in  Michigan,  as  indicated  by  the  per  cent  of  all  the  weekly 
card-reports  which  stated  the  presence  of  Typhoid  Fever. 


Year,  and 
period  of  years. 

Av.     Total     Annual 
Kainfallat  Stations 
in      Michigan,      in 
inches. 

d.a 

KM 
.5 

53-3 

Inches      of       Earth 
above    the    Ground 
Water  at  Lansing. 

.a  IS 

^: 

u  SI    . 
OgM 

-a     S 

Ground  Water,  higher 
(+)    or    lower    (— ) 
than  the  six   years' 
Average  in  inches. 

Av.  Per  Cent  of  all 
Weekly       Card-Re- 
ports   Stating    the 
presence  of  Typhoid 
Fever. 

More    (+)     or     less 
(— )    Sickness   from 
Typhoid  Fever  than 
the  six  years'  aver- 
age. 

Av.  6  Y'rs,  1885-90.- 

30.96 

29.15 

291 

32 

= 

9 

= 

1885 

35.82 
32.16 
29.82 
29.55 
28.18 
30.20 

34.51 
29.52 
30.08 
25.76 
23.28 
31.73 

284 
281 
290 
294 
304 
292 

40 
42 
34 
29 
10 
28 

+  7 
+10 

+  1 

-  s 

-13 

+  1 

8 
8 
10 
10 
10 
8 

—1 
—1 

+1 
+1 
+1 
-1 

1886 

1887 

1888 

1889 

1890 

TYPHOID  FEVER  IN    MICHIGAN  IN  1890.  233 

Table  14  is  a  summary  of  the  facts  presented  in  tables  8  and  9,  with  the 
addition  of  the  facts  relative  to  the  height  of  water  in  the  well  at  Lansing. 

From  the  evidence  given  in  this  table  (14)  it  appears  that,  notwith- 
standing increased  population  and  more  numerous  and  better  reports  from 
local  health  officials,  the  reported  prevalence  of  typhoid  fever  in  Michigan 
was  less  in  1890  than  in  either  of  the  previous  three  years;  and  also  than 
the  average  for  the  six  years  1885-90.  The  rainfall,  both  throughout  the 
State  and  at  Lansing,  was  greater  in  1890  than  for  either  of  the  previous 
three  years;  and  at  Lansing  was  more  than  the  average  for  the  six  years 
1885-90.  In  this  connection,  it  is  proper  to  hold  in  mind  the  fact  that  the 
efforts  of  the  State  Board  of  Health,  the  issuing  of  leaflets,  diagrams  and 
other  literature  bearing  upon  the  restriction  and  prevention  of  typhoid 
fever,  have  continued  for  a  number  of  years,  and  there  is  reason  to  believe 
that  the  influence  of  that  work  is  increasing;  possibly,  if  it  were  not  for 
that  work,  the  typhoid  sickness  during  1890  might  have  been  as  much  or 
more,  than  in  the  preceding  years,  notwithstanding  increased  rainfall  and 
water  in  wells. 
30 


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^mm 


